What to Do When Someone Has a Seizure

Call 911 if the seizure lasts five minutes or longer, repeats, is the person’s first, or comes with a fever, an injury, or breathing difficulty. Do not put anything in their mouth. Do not try to hold them still. Cushion the head and move hard objects away.

The two most widely believed pieces of seizure first aid are both wrong, and both cause harm.

The American College of Emergency Physicians is unambiguous:

“Do not put anything in the person’s mouth.”

“Do not attempt to restrain the convulsions.”

Nothing in the mouth — no wallet, no spoon, no fingers, no rolled cloth. The old idea about swallowing the tongue is not a thing that happens, and what does happen is broken teeth, a bitten rescuer, and an obstructed airway.

And do not hold them down. The movements will not stop because you are pressing on them, and holding a convulsing person still causes injury to both of you.

What to do instead

ACEP’s instructions, and there are only a few:

Clear the space. “Move harmful objects out of the way, cushion the head and protect the person from falling.”

Loosen anything at the neck — “Loosen ties, scarves or other neckwear.”

Then, once the convulsion stops: “After the convulsion ceases or if the person is vomiting, roll the person onto his or her left side to protect the airway and to help drain away any mouth secretions.”

The left side specifically, and not until the movements have stopped — or sooner if they are vomiting.

That is the whole of it. You are protecting a head and then a airway. There is nothing to do during the seizure itself except keep them from being hurt by their surroundings.

And the job almost nobody knows they have

ACEP asks bystanders to be a witness, because the person cannot be:

“Observe the length of the seizure, the movements involved, direction of head and eye movements and the time it takes to return to full consciousness and alertness, so you can report this information to a medical professional.”

Four things: how long, what moved, which way the head and eyes went, and how long until they were properly back.

Look at a clock. A seizure feels vastly longer than it is, and the five-minute threshold below depends on a real number rather than a remembered one. If you can start a timer, start one; if you can only note the time it began, do that.

And the head-and-eye direction sounds like an odd thing to ask of a frightened bystander — it is genuinely useful clinical information, and nobody else in the room will have it.

Call 911 if any of these apply

Quoted from ACEP:

• “The seizure lasts five minutes or longer or is repeated.”
• “Injuries have resulted from the seizure.”
• “The person experiences persistent breathing difficulty.”
• “The person having the seizure also has a fever.”
• “The person experiences persistent confusion or remains unconscious.”
• “The person is pregnant, is a diabetic, is injured or appears to have life-threatening conditions.”
• “This is the first time the person has had a seizure, or, in the case of an established epileptic, the seizure represents a marked change from the type or duration of seizure typically experienced.”

Two of those deserve pulling out.

A first seizure is always a 911 call, however brief and however completely the person recovers. A first seizure is a new event that needs explaining, and the explanation can be urgent.

And for somebody who has epilepsy, the test is change — not whether they had a seizure, but whether this one was different in type or length from their usual. The person who knows that is usually them, or the person who lives with them. Ask, and if nobody is sure, call.

A fever with a seizure is on the list too, which is why it also appears on our adult fever page.

Afterwards

Stay with them. Confusion, drowsiness and not remembering the event are ordinary afterwards, and somebody in that state should not be left alone, driven anywhere by themselves, or asked to make decisions.

Nothing to eat or drink until they are fully alert.

Come to an emergency room for a first seizure, a seizure that was different from usual, any injury sustained during it, a seizure in pregnancy, or a seizure in somebody with diabetes — and for anybody you are simply not happy about.

Our emergency rooms are open every hour of every day and are walk-in, with CT, X-ray and a full laboratory in the building. Go to the nearest one, and if another emergency department is closer to you, that one is the right answer tonight.

If you are unsure, come in — this list is not exhaustive and you are not expected to judge whether a seizure was a normal one.

Questions people actually ask

It only lasted about a minute and they seem fine now. If it was their first, call 911 anyway — ACEP puts a first seizure on the 911 list regardless of length. If they have epilepsy and it was typical for them, the test is whether this one was different.

Should I put them in the recovery position straight away? After the convulsion stops, or sooner if they are vomiting. ACEP specifies rolling them onto the left side. Not during the movements.

They bit their tongue and it is bleeding. That is an injury resulting from the seizure, which is on ACEP’s 911 list. Do not put anything in the mouth to prevent it — that is how the worse injuries happen.

They have epilepsy and this happens regularly. Then you and they already know their pattern, and the question is whether this one broke it. Longer, different, repeated, or slower to come round means call.

Can I give them their medication? Not while they are not fully alert, and not on the advice of a web page. If they have a rescue plan from their own team, follow that plan.

What if I cannot tell whether it was a seizure at all? Describe what you saw rather than naming it. “He went stiff and shook for about two minutes and took ten minutes to answer me” is more useful than a diagnosis, and it is exactly what ACEP asks you to record.

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Five minutes or longer, repeated, a first seizure, or one with fever, injury or breathing difficulty — call 911. Nothing in the mouth, and never restrain the movements. Both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: which door do you need · fever in an adult

Sources

47. Seizures — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/seizures

This article is general information, not a diagnosis. It gives no doses. If you are unsure, come in — this list is not exhaustive and you are not expected to judge a seizure yourself. If it might be an emergency, treat it as one and call 911.